Pharmacological interventions for non-alcohol related fatty liver disease (NAFLD)

Lombardi, Rosa; Onali, Simona; Thorburn, Douglas; Davidson, Brian R; Gurusamy, Kurinchi Selvan; Tsochatzis, Emmanuel

doi:10.1002/14651858.cd011640.pub2

Cited by 53 publications

(51 citation statements)

References 184 publications

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“…An understanding of the demographic and clinical factors associated with disease progression and mortality can lead to better stratification of high‐risk patients and support the efforts of public health policy makers to target interventions to those patients at greatest risk of more rapid disease progression. This is particularly relevant as novel medical therapies for NAFLD/NASH with the potential to halt or reverse disease progression undergo evaluation 18‐20 . Furthermore, the late identification of NAFLD/NASH in real‐world clinical practice and the high clinical burden found in this study for Medicare patients have broad public health implications.…”

Section: Discussionmentioning

confidence: 93%

“…Treatment guidelines currently do not recommend screening to identify NAFLD/NASH patients based on evidence that such screening is not cost‐effective due to limited efficacy of currently available treatment options 17 . However, with promising novel NAFLD/NASH interventions currently under development and review, and the substantial under‐diagnosis of NAFLD/NASH in the Medicare population, the impetus may be increasing for the need of an algorithm to identify individuals at high risk of NAFLD/NASH 18‐20 . Such an algorithm may decrease the clinical burden of the disease by helping to identify pre‐symptomatic patients and thereby allowing for earlier clinical intervention and management.…”

Section: Discussionmentioning

confidence: 99%

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Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data

Loomba¹,

Wong

Fraysse

et al. 2020

Aliment Pharmacol Ther

113

121

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Background: Risk factors and timing associated with disease progression and mortality in nonalcoholic fatty liver disease (NAFLD) are poorly understood. Aims: To evaluate the impact of disease severity, demographics and comorbidities on risk of mortality and time to progression in a large, real-world cohort of diagnosed NAFLD patients. Methods: Claims data from a 20% Medicare representative sample between 2007 and 2015 were analysed retrospectively. Adults were categorised into disease severity groups: NAFLD/nonalcoholic steatohepatitis (NASH) alone, compensated cirrhosis, decompensated cirrhosis, liver transplant or hepatocellular carcinoma.Cumulative incidence of mortality and disease progression were calculated for each group and multivariate analyses performed adjusting for demographics, comorbidities and disease severity.Results: A total of 10 826 456, patients were assessed and the prevalence of NAFLD was 5.7% (N = 621 253). Among patients with NAFLD, 71.1% had NAFLD/NASH alone and 28.9% had NAFLD cirrhosis. Overall, 85.5% of patients had hypertension, 84.1% dyslipidemia, 68.7% had cardiovascular disease and 55.5% diabetes. The cumulative risk of progression of NAFLD to cirrhosis, and compensated cirrhosis to decompensated cirrhosis was 39% and 45%, respectively, over 8 years of follow-up.The independent predictors of progression included cardiovascular disease, renal impairment, dyslipidemia and diabetes. The cumulative risk of mortality for NAFLD, NAFLD cirrhosis, decompensated cirrhosis and hepatocellular carcinoma was 12.6%, 31.1%, 51.4% and 76.2%, respectively. Conclusions:The present report (a) demonstrates that NAFLD is grossly underdiagnosed in real-world clinical settings and (b) provides new evidence on the progression rates of NAFLD and risk factors of mortality across the spectrum of severity of NAFLD and cirrhosis.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data

Loomba¹,

Wong

Fraysse

et al. 2020

Aliment Pharmacol Ther

113

121

View full text Add to dashboard Cite

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“…The major issue in this field is the scarcity of high-quality, randomized, blinded, adequately powered, controlled trials of sufficient duration and with clinically relevant endpoints. In line with this consideration, a recent Cochrane review 170 concluded that "we are very uncertain about the effectiveness of pharmacological treatments for people with NAFLD, including those with NASH". Some concerns also remain about the longterm safety of the available drugs, necessitating thoughtful balancing of the potential risks and benefits.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Nonalcoholic fatty liver disease and chronic vascular complications of diabetes mellitus

2017

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Nonalcoholic fatty liver disease (NAFLD) and diabetes mellitus are common diseases that often coexist and might act synergistically to increase the risk of hepatic and extra-hepatic clinical outcomes. NAFLD affects up to 70-80% of patients with type 2 diabetes mellitus and up to 30-40% of adults with type 1 diabetes mellitus. The coexistence of NAFLD and diabetes mellitus increases the risk of developing not only the more severe forms of NAFLD but also chronic vascular complications of diabetes mellitus. Indeed, substantial evidence links NAFLD with an increased risk of developing cardiovascular disease and other cardiac and arrhythmic complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus. NAFLD is also associated with an increased risk of developing microvascular diabetic complications, especially chronic kidney disease. This Review focuses on the strong association between NAFLD and the risk of chronic vascular complications in patients with type 1 diabetes mellitus or type 2 diabetes mellitus, thereby promoting an increased awareness of the extra-hepatic implications of this increasingly prevalent and burdensome liver disease. We also discuss the putative underlying mechanisms by which NAFLD contributes to vascular diseases, as well as the emerging role of changes in the gut microbiota (dysbiosis) in the pathogenesis of NAFLD and associated vascular diseases.

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“…Lifestyle modification is the mainstay of treatment, with uncertainty regarding the effectiveness of drug therapy for patients with NAFLD 1. Exercise intervention studies demonstrate that exercise effectively reduces liver fat, even in the absence of significant weight loss.…”

Section: Contextmentioning

confidence: 99%

High-intensity exercise offers no additional benefit to moderate-intensity exercise in reducing liver fat in patients with non-alcoholic fatty liver disease

Cuthbertson

Sprung

2017

Evid Based Med

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Pharmacological interventions for non-alcohol related fatty liver disease (NAFLD)

Abstract: Due to the very low quality evidence, we are very uncertain about the effectiveness of pharmacological treatments for people with NAFLD including those with steatohepatitis. Further well-designed randomised clinical trials with sufficiently large sample sizes are necessary.

Cited by 53 publications

References 184 publications

Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data

Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data

Nonalcoholic fatty liver disease and chronic vascular complications of diabetes mellitus

High-intensity exercise offers no additional benefit to moderate-intensity exercise in reducing liver fat in patients with non-alcoholic fatty liver disease

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